Despite overtures by Democrats and Republicans to work together, it is now certain that if health care reform is to move forward it will do so in the same fashion it has over the past year: primarily as a Democratic effort. At this point, the most contentious negotiations are between chambers, rather than between the parties, as House and Senate leaders inch toward an agreement on a final package.

If anything, the much-anticipated health care summit late last month provided an opportunity for legislators in both parties and President Barack Obama to explain themselves and make their case to each other and to the American people. But while the summit illustrated that there is broad agreement among leaders of both parties that health care needs to be reformed, Members are at an impasse regarding how to address the issue in a bipartisan fashion.

The past few weeks have seen Obama step forward to take the central leadership role after nearly a year of letting Congressional leaders take the lead in writing two overhaul bills. After releasing an outline of a compromise on Feb. 22 and presiding over discussions at the summit, Obama painted a path forward with broad brush strokes in a brief speech at the White House on Wednesday.

Critics say this push comes too late, after Republicans had time to win the messaging war by painting the overhaul as socialized medicine or a government takeover of the health care system, making vulnerable Democrats increasingly nervous about supporting the legislation in an uncertain election year. To some analysts, the election of Sen. Scott Brown (R) in the Jan. 19 Massachusetts special election seemed to suspend the overhaul indefinitely. But Obama both acknowledged and dismissed these political concerns Wednesday, saying emphatically, I dont know how this plays politically, but I know it is right. And so I ask Congress to finish its work.

In a letter to Congressional leaders of both parties on Tuesday, Obama reiterated the points of agreement between Republicans and Democrats while acknowledging important areas of disagreement. He outlined four policy priorities identified by Republican Members at the meeting that he would be willing to explore further, noting, I said throughout this process that Id continue to draw on the best ideas from both parties, and Im open to these proposals in that spirit.

However, it seems highly unlikely that Obamas consideration of these priorities will win over Republicans, whose opposition to reform runs far deeper, to issues of the legislations scope and theories of state and federal government control. House Minority Leader John Boehner (R-Ohio) rejected Obamas proposal to incorporate Republican priorities, replying, There is no reason to lump sensible proposals into a fundamentally-flawed 2,000-page bill.

Republicans, many of whom have repeatedly paraded paper copies of the 2,000-plus-page bills at news conferences and speeches, continue to argue in favor of a step-by-step approach to reform.

Americans are telling us to scrap the bills they have already rejected and start over with common-sense, step-by-step reforms we can all agree on, McConnell said.

Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, said after the summit, There really isnt a clear path forward for even the limited areas of agreement that were discussed at the summit to move forward. Theres a limited amount of time until the election. He added, That may not be the end of the process, but I think were looking at some partisanship for the next few weeks at least.

Feeling the Urgency

In the meantime, interest groups have dug in their heels. Advocates and legislators pushing for comprehensive reform used recent House Energy and Commerce subcommittee hearings on Anthem Blue Cross dramatic increase in premium rates in California as an illustration of the dire state of health care in America.

Comprehensive reform is now more urgent than ever, AFL-CIO President Richard Trumka said in a recent statement. You need look no further than the unconscionable price increases being pushed onto consumers from insurance companies. He continued, It is inexcusable that the insurance and drug companies, who have made billions in profits off the backs of working families, are fighting these common sense reforms.

But while the president and Democratic leaders argue that health care reform will boost the economy, other interest groups disagree. R. Bruce Josten, executive vice president of government affairs at the U.S. Chamber of Commerce, said that uncertainty created by health care reform has become a cloud that hangs over businesses and the economy.

Reconciliation?

As Democrats insist that reconciliation is simply a process of putting the legislation to an up-or-down vote, Republicans continue to paint the Democrats likely use of this procedure as an attempt to jam the legislation through Congress. Democrats also point out that a Senate health care overhaul bill already passed the Senate with a supermajority of 60 votes in December.

Obama noted this in his speech on Wednesday, adding that Congress owes the American people a final vote on health care reform after years of debate and two votes to pass legislation in the House and Senate. While he didnt mention reconciliation by name, he did refer to previous pieces of landmark laws that had passed through that process in the past, saying that health care legislation deserves the same kind of up-or-down vote that was cast on welfare reform, the Childrens Health Insurance Program, COBRA health coverage for the unemployed and both Bush tax cuts.

As House and Senate leaders move forward with the overhaul, they will have to work to keep their caucus on board. With voters uneasy about the overhaul and political forecasters predicting Republican gains in November, it will take significant legislative maneuvering for the Senate overhaul bill to succeed in the House, which only narrowly passed its bill in November by a vote of 220-215. Democrats in the Senate predicted last week that, should the Senate move forward with a reconciliation proposal, it will be far easier to get 50 votes in that chamber than it will be to get the necessary 216 votes needed for passage in the House.

Senate Majority Whip Dick Durbin (D-Ill.) said last week that Democrats were coming to closure on revised language written jointly by Congressional lawmakers and the White House and planned to send legislative language to the Congressional Budget Office for scoring soon. He acknowledged the difficulties in assuring the proposal will pass the House, saying the Senate would provide some sort of convincing gesture to anxious House Democrats that Senators will adopt their desired changes. Whips in both chambers have said they are waiting until they have an agreement before counting votes for the deal.

In the meantime, Republican leaders warn that, even if Democrats manage to sign a health care overhaul into law this year, the fight will continue. Speaking on Fox News last week, Senate Republican Conference Chairman Lamar Alexander (Tenn.) said: So at a time when jobs, terror and debt are our big issues or should be, here we are wallowing around on health care. And then if they should pass it, what is going to happen? Therell be an instant campaign to repeal it. That will go between then and November.